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A Market in Morals

Friday, January 26, 2007

Thanks to the global diversity of bioethics rules, would-be mothers have a world of options.

A decade ago, Stephen Blood came down with bacterial meningitis. As he lay comatose, doctors following his wife’s instructions extracted his live sperm. The couple had been trying to conceive for years, and Diane did not see her husband’s comatose state as a reason to stop trying. He ultimately died from the meningitis infection. When Diane wanted to use the sperm—which was watched over by Britain’s Infertility Research Trust—she hit an obstacle. The United Kingdom’s Human Fertilisation and Embryology Authority refused to release the semen, saying Stephen had never given consent. Blood battled the UK government for years, and when she finally won the sperm, she did what increasing numbers of Brits are doing today: She took it to Belgium, where the laws are lax and the fertility clinics abundant.

Blood was only skipping town to buy a service—artificial insemination— but an itinerant woman in search of a baby now has far more options before her. If you’re a European citizen, chances are your country of origin either proscribes compensation for donor eggs, prohibits the anonymous sale of sperm, or bans the rental of wombs. But reproductive freedom may lie just a high-speed train ride away, over a border and into a different legal regime. Moral pluralism in Europe and elsewhere has created a fascinating patchwork of reproductive prohibitions, leading more permissive states to specialize in different parts of the embryo assembly line.

IVFTake the simplest of genetic commodities, sperm. Something may well be rotten in the state of Denmark, but the semen is fresh—and among the most sought after in the world. In 2005, Britain banned men from anonymously selling their sperm, and supply plunged. Norway and Sweden followed suit. Famously liberal Denmark, by contrast, simply expanded its donor pool. The tiny country is a net exporter of semen, and it is squeezing profit from its sought-after genetic bounty: blond hair, blue eyes, and viking stature. The London Times reports that Danish sperm is selling at €26.4 per 0.4ml straw, far less than a vial will set you back stateside and, to be sure, amid the shortages of the United Kingdom. Brits are encouraged to make a holiday of it. “You can fly Ryanair from Stansted, and we have deals with hotels,” one Danish fertility doctor told the Times last year, “fertility tourists get a discount.”

Baby-minded tourists in want of sperm will find Denmark amenable, but women who need eggs are out of luck: the country has banned their sale. If you ask for ova in Denmark, they’ll likely direct you south, to Spain, the egg seeker’s destination of choice on a continent with widespread shortages. The European shortages are not just due to the lack of anonymity, but also to caps on compensation; a British college student looking to sell her eggs will find her compensation capped at £15. By contrast, Spanish women are given $1,000 for their trouble—still only 1/10 of what an American donor could expect, but enough to assure a steady supply. Despite the increased cost of compensation, the relative abundance of Spanish donors has pushed prices down. “It's actually cheaper for me to use a donor egg in Spain,” one British woman told the Guardian last year, “than it is to use my own eggs at home.”

The rental of wombs—known as surrogacy—is possibly the most emotionally fraught of baby-making transactions, and Europe is at least as split over its legality as the sale of eggs and sperm. Verboten in Germany, France, and the Czech Republic, surrogate motherhood is still tolerated in the U.K. and Greece. But mothers looking for a bargain are likely to look outside of Europe, to India, where renting a womb for 9-months will cost British parents less than renting a London flat for the same period: between $2,500 and $6,500.

Moral pluralism in Europe and elsewhere has created a fascinating patchwork of reproductive prohibitions, leading more permissive states to specialize in different parts of the embryo assembly line.

It would be a mistake to cast Europe as a patchwork of yeses and noes; of suppression and sanction. Call them embryology labs of democracy: Each nation has responded to the questions raised by new reproductive technologies by crafting an anomalous legal regime. France, for instance, hasn’t banned sperm sales, but single women and women past “reproductive age,” are shut out of the market. Italy permits in vitro fertilization using a woman’s own eggs, but not donated ones. Doctors can't fertilize more than three eggs at a time, and they can’t screen any of those embryos before implantation.

Modern Europe can seem a chaotic place for an infertile couple, but these many tangled webs of regulation form a more permissive whole. Reproductive policy, like  taxes, benefits from jurisdictional competition. Regulators face pressure to permit their citizens ample choice, lest they take their aspirations elsewhere. Governments who want to retain any control whatsoever over the reproductive choices of their citizens may do best to keep prohibitions in check. In 2000, the Swiss Federal Council rejected a referendum initiative that would have banned most forms of IVF. Opponents simply stated the obvious: Infertile Swiss women needn’t confine themselves to Switzerland. Diane Blood, having taken her dead husband’s sperm to Belgium, later fought and won to have her husband’s name placed on her son’s UK birth certificate—a battle that wouldn’t have even taken place absent the disparity in neighboring legal regimes.

Europeans who find IVF technologies profoundly disturbing—and there are many, especially in Germany and Italy—are well aware that the freedom to travel is the freedom to inseminate.  A 2005 report on surrogacy from the European Council reads “The Assembly notes that differences in legislation have prompted some couples living in a country where the practice is prohibited to go abroad….At present, these disparities between national situations are causing legal insecurity and giving rise to damaging consequences.” The European Parliament has declared that it wants egg donation “strictly regulated” across the board.

Would-be regulators are right to note that European standardization is their best hope, but the walls they build will be porous. Wealthy Europeans can always come to the U.S. or India, and every price break on lowers barriers to the controversial trade. The continent’s current compromise with the baby business is probably the right one for a plural society with sharply different answers to brand new questions. Social conservatives are free to declare “not in my backyard”—while their neighbors lay the groundwork for a growing global trade in reproduction.

Image credit: Flickr user griff le riff

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